Prognostic Value of Perfusion-Weighted Imaging in Brain Glioma: A Prospective Study

Acta Neurochir (Wien). 2006 Mar;148(3):277-85; discussion 285. doi: 10.1007/s00701-005-0718-9. Epub 2006 Jan 19.

Abstract

Object: Biopsy targeting based on MR imaging alone may fail to identify malignant areas in brain gliomas. Considering the differences in relative Cerebral Blood Volume (rCBV) ratios reported among tumour grades, we evaluated whether perfusion-weighted MR imaging (PWI) could usefully implement the routine preoperative imaging by detecting those areas bearing a higher yield for malignancy to guide the stereotactic biopsy or the surgical removal.

Clinical material and methods: We studied a series of 55 consecutive patients with newly diagnosed brain glioma using both conventional MR imaging and PWI in the preoperative assessment. The pathological diagnosis was established by stereotactic biopsy in 29 cases and by craniotomy in 24 cases. We evaluated the patient survival to detect undergrading.

Discussion: Independent from contrast-enhancement, perfusion-weighted MR imaging improved the target selection in stereotactic biopsy guidance and the removal of malignant areas in tumours amenable to surgery. Particularly sensitive to the perfused part of the tumour as to small regional changes, rCBV maps allowed a better detection of malignant areas. The rCBV ratios correlated significantly to the tumour grade and the final outcome (p < 0.01).

Conclusions: We found PWI valuable in the preoperative assessment of brain gliomas, discriminating high from low-grade gliomas. PWI can easily be performed on widely available MR imaging systems as part of the routine imaging of gliomas.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Brain / blood supply
  • Brain / pathology*
  • Brain / physiopathology
  • Brain Mapping / methods
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / surgery
  • Cerebral Arteries / physiopathology
  • Cerebrovascular Circulation / physiology*
  • Child
  • Diagnostic Errors / prevention & control
  • Female
  • Glioma / diagnosis*
  • Glioma / surgery
  • Humans
  • Magnetic Resonance Angiography / methods*
  • Magnetic Resonance Angiography / standards
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Preoperative Care / trends
  • Prognosis
  • Prospective Studies
  • Stereotaxic Techniques / standards